HomeMy WebLinkAboutBuilding Permit Application y
ALLAPPLI�ABLE I FOM ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ;lam Permit Number:
Ir •
Building Permit Application OCT 16 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St.Lucie County
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PI30OSEDrI PROVEIVIE�7T LOCATIO
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Address: laa "stc-e'e-k
Legal Description: JL.r r\ c r C.5fQ+e_S
Property Tax ID#:'?Lf6�L--(ohL-1 6l3 2-4)6o- o Lot No. <.
Site Plan Name:()6h n Rrer- c''So n Block No. 15
Project Name: -
Setbacks Front Back: Right Side: Left Side:
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Additionalworkto e e Orme under tis —checkpermit a apply:
E1HVAC Gas Tank ❑Gas Piping F-l_Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers 11 Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ ,�1s Ll I. 3 Utilities:)Sewer Septic Building Height:
S s r 7 at„ t. n::.
�QWNER/LSE ��, r p� � ; .F CON>fRi4CTOR' , ,
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Name_�nkn or !�)Prn1"- P0,1e.rS6n Name:-�a e15�-D Ckm � s sICU.,sier-
Address:_-a, 15 LAS✓ C'e_er7t" Company:7-.l- 0 QcLr -'6_ �.-
City: p ,e_c .P State: -1,H Address: (Iq (e 1 '79 ' T'
Zip Code: 3L404 g a Fax: City: \w:' e�ca.0. State: �-
Phone No.")7a:-5(Q C) Zip Code::3aL4 1 -QL Fax: S(aI ."RP;:5= 514
E-Mail: Phone No. 5161 a
Fill in fee simple Title Holder on next page(if different E-Mail:
from the owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required_.
ilSI�P N AL�CO�S tUCTION LIEN LAWrINfORMATI(�7N u , r.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: ' Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commepcing work orrecording your Notice of Commencement.
't' C) .- �'� s
_Signat r of Owner/Lessee/Agent tgnature of Contractor/License Holder
STATE OF FLORID ` STATE OF FLO A /
COUNTY OF ��t g e- COUNTY OF G1, be-Ar�l
The for in instrujj��e.t was_ac�snowled a efore me The forgoing instrument as acknowledged before me
this flay of •L i� ���N 20 by this�day of - 20 -4! by
' V 1 &N`S 0 V)
I- 4r-ne � D 0.0 ",s
(Name of person acknowledging) (Name of person acknowledging)
""fill� J<24 e:��
(Signature of Notary Public-State of Florida) (Signat a of Notaryublic- to of Florida)
Personally Known OR Produced Identification Personally Known AR OProduced Identification
Type of Identification Produced bVl<J� C i�(y'� �� YPe of Identification Produced
Commission N&—1 alffif of aPrlA.DvSahm Commission No. �� `YP�B<% ANGEI$ G
AI Q NOTARY PUBLIC Y COMMISSION#FF 951069
a -+STATE OFF "r c¢ EXPIRES:April 12,2020
3W44-41,10-
" =Comrn#GG130649 Opp. BudpotNotafySeMoos
Revised 07/1S/2014 s4N4 �1e Expires 10/20/2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
.INITIALS i